A Lipoatrophic Syndrome Acquired in a Type 1 Diabetic Patient

Aims: Lipoatrophies can have multiple causes. Insulin lipoatrophies are among the rare causes. We report the case of patient with type 1 diabetes, with an acquired lipoatrophic syndrome.

Case Presentation: This was a 19-year-old patient who had been hospitalized in the Diabetology and Nutritional Diseases Department C of the National Nutrition Institute in Tunis for the balancing of diabetes. She has been known to have diabetes for 4 years under Neutral Protamine Hagedorn insulin (NPH insulin) basal bolus complet regimen. She had no other medical history including autoimmune. Her diabetes is poorly monitored, poorly balanced (HbA1C = 9.1%) and uncomplicated. The rotation of the injection sites was well performed by the patient. Her body mass index (BMI) was 19.2 kg/m2. The lipoatrophic lesions appeared a year ago and are found at the sites of insulin injection. Their sizes have been stable for 6 months. The lipid parameters were normal. The insulin requirement was 0.4 IU / kg / day. The therapeutic approach was to prohibit injections at the lesions installed, associated with local corticosteroid therapy. Regular monitoring of the progress of these lesions was planned.

Conclusion: This observation suggests that these lipodystophies are most likely of autoimmune origin. They cause diabetes imbalance in addition to their unsightly nature. The treatments currently used have not shown very good effectiveness, especially for extensive lesions already installed.